We've had several discussion about different insanity rules, insanity points, etc. So far I've been too cheap to spring for CoC, but here's my idea:

Each of the "maddening" activities in the module contributes one or more points of madness (not insanity pts :-) ). Each activity can only impact a character once. Each of these steps moves the character farther along the progression of nuttiness. In some cases the effects should replace those designated in the module.

Example Steps:Any time you take temporary Wis damage from a Tharizdun effect.Any time you sacrifice a creature or magic item on an altar to Big T.

Moathouse:Eating Tharizdun's giftDrinking the ghastly waterAny of the other effects which knocks a character outGetting hit by a bead of force (only from the 'artifacts')Curse of Tharizdun from area 32D (4 points)Failed save in area 34A

CRM:Getting hit by the wasting disease near the fire templeGetting energy drained by a vampire or spectreBeing captured and torturedBeing posessed by the demon amulet (2 points!!)

Inner/outer fane:Any contact with tharizdun's magical artifactsAny contact with tharizdun's magical artifactsReading Heddy's Grimoires (1 point for the one, 3 points for the other)Dying from a cleric's death attack (slay living, destruction, etc.)Carrying any artifact of T (orb, light saber, force rings) - only while you carry it.3 points - getting a demonic addition (you can get two back per below).

Progression:1 - 2 points: Nasty dreams3 points: Character occasionally mutters dark truths or babbles about Tharizdun's unstoppable return. Plus, from here on out you must make a Fear save (per the spell) anytime you encounter one of the above effects. The DC is 10+Madness points. The duration is amount failed^2. If you make the save you are still "shaken" for d4 rounds.4 points: In your heart of hearts, you know Tharizdun is real and coming back. -1 to any Will saves from spells/effects of Clerics of tharizdun.5 points: Welcome to the club! Gain 1 insanity point. Use the positive modifier as an adjustment either to your spells DC or to skill checks involving STR or CHA (choose one). You now also qualify to be a DD. Oh yeah, and those dreams, sometimes they happen when you are awake.6 points: You now prefer darkness to light. Gain a -1 penalty to all checks in sunlight.7 points: You now hear dark whispers to do terrible things. Once per day make a will save (DC 15) or perform a single unspeakable act. If you can't think of a good one, the character uses his/her strongest attack on the weakest available friendly opponent.8 points: Whew! And we thought Liberace was nuts. If you are Good-aligned, you move to Neutral. If you are Neutral already, why not consider Evil? Work this out in a dialog with the player, do not force the alignment change, yet.9 points: Congrats, any supernatural creatures now think you are a member of the cult. No need to "pretend" anymore. You suffer no more fear effects or other effects designed to frighten intruders.10 points: Go directly to CE, do not pass go, do not warn your fellow party members.

How to lose points:-1 point: whacking a DD or any high priest of the temples in the CRM (as many as you can kill)-1 point: a heal or greater restoration spell (once)-1 point: 1 month passes since last sanity-disrupting effect (once)-2 points: Just for being a paladin (once)-1 point: Per atonement quest (multiple) or achieving a major victory for a GOOD god.-1 point: for completing the creation of a magic item worth more than 2,000 (once).-1 point: for completing the creation of a magic item worth more than 20,000 (once).-1 point: limited wish (once)-1 point: removing your demonic addition-1 point: getting your old limb back-all points: wish, miracle, etc.